| dc.description.abstract | A retrospective study was carried out on thirty
brain dead patients admitted to the intensive
care unit (I.C.U.) at the Kenyatta National Hospital
(K.N.H.) from January 1976 to December 1985.
There were 20 males (66.7%) and 10 females (33.3%),
therefore a male:female ratio of 2:1.
The average age of these patients was 24.4 years
and ranged from three to sixty years, with 50% of
the patients below 20 years of age.
The thirty patients were admitted for a total of
155 days in the intensive care unit, with an average
of 5.16 + 0.25 days in the unit. One patient had a
diagnosis of brain death with eclampsia on admission,
and the diagnosis was confirmed before the heart
stopped only after a few hours in the unit.· One
patient was in the unit for a total of 15 days.
The interval between the diagnosis of brain death
to an isoelectric electrocardiogram (ECG) ranged
from a few minutes to eight days after admission.
About 50% of the patients got an isoelectric ECG
less than one day after brain death was diagnosed
clinically. Of the remaining fifteen patients
50% had isoelectric ECGs in less than three days
after clinical diagnosis.
Thirteen of the patients (43.4%) had head injury
as a cause of brain death, four patients (13.4%)
had brain tumours, three (10%) had cerebral anoxia
following cardiac arrest; two patients (6.7%) had
cerebral vascular accident, two had eclampsia,
while one each had, aneurysm, encephalitis, asprin
poisoning, tuberculous meningitis, craniovertebral
anomaly, and one was admitted with coma of unknown
origin which was later diagnosed as meningitis.
On admission, two patients, both with head injuries
were intoxicated with alcohol, one patient was on
phenobarbitone, and one had diazepam on admission
as a stat dose to stop convulsions.
All patients required ventillatory support. Twenty
six (86.7%) were put on the ventillator due to
total apnoea, four (13.3%) due to inadequate
ventillation, and no patient was on muscle relaxants.
On diagnosis of brain death all patients had non-reacting
pupils and no motor response in the distribution
of the cranial nerves. Vestibulo-occular
reflex (caloric) was tested and found negative in
twelve patients (40%). Oro-pharyngeal reflex (gag)
was tested and found absent in eight patients
(26.6%). Corneal reflex and atropine test each done
and negative in four patients (13.3%) Dolls
eyes were tested and found absent in six patients
(20%). Apnoea test was not tested in any of the
patients.
Confirmatory tests of brain death were carried out
in fifteen patients (50%). The electroencephalogram
(EEG) was done and found to be isoelectric in fourteen
patients (46.7%), and cerebral blood flow was
tested in one patient by carotid angiography and
found to be absent.
The fourteen patients who had EEG done, six had it
done twice, while in the other eight, it was done
once.
In twenty four patients (80%) the diagnosis was
made by the consultant, and in four, the diagnosis
was made by the registrar. In two patients no
information was available.
Eleven patients (36.7%) had at least one cardiac
arrest in the unit before the clinical diagnosis
of brain death was made. Three of these had a
cardiac arrest twice, and each time successfully
resuscitated. Where the duration of cardiac arrest
was indicated it ranged from a few seconds to
fifteen minutes.
In fifteen patients (50%) the treatment was unchanged
after diagnosing brain death. Eleven of the remaining
patients had all drugs withdrawn with only intravenous
fluids remaining, and four had the number of
agent | en |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
